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In Reply: Mr Steen and colleagues make some very important observations, with which we largely agree. It is true that at the time our study was conducted in Nairobi the population incidence of bacterial genital ulcer disease due to chancroid and syphilis had declined considerably, probably related to the impact of effective treatment and prevention programs.¹ However, despite the low incidence of bacterial genital ulcer disease, the incidence of the nonulcerative bacterial STIs gonorrhea and chlamydia was still relatively high in our cohort of female sex workers and was markedly reduced by monthly antibiotic treatment and prophylaxis with azithromycin. The presence of these STIs is believed to represent an important risk for HIV-1 acquisition in female sex workers, and so the fact that their treatment, reduction, or prevention did not reduce HIV incidence requires explanation.

One reason could be that gonorrhea and chlamydia infection are less important cofactors in facilitating . . . [Full Text of this Article]

Rupert Kaul, MD, PhD
rupert.kaul@utoronto.ca
Clinical Science Division
Department of Medicine
University of Toronto
Toronto, Ontario

Stephen Moses, MD, MPH
Department of Medical Microbiology
University of Manitoba
Winnipeg, Manitoba

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